P52.5
BillableSubarachnoid (nontraumatic) hemorrhage of newborn
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P52.5 an HCC code?
Yes. P52.5 maps to Cerebral Hemorrhage under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for P52.5
For P52.5 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed P52.5 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P52.5 is the ICD-10-CM diagnosis code for subarachnoid (nontraumatic) hemorrhage of newborn. Bleeding in the space between the brain and the innermost membrane surrounding it in a newborn without trauma. P52.5 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering hemorrhagic and hematological disorders of newborn (p50-p61).
Under the CMS-HCC V28 risk adjustment model, P52.5 maps to Cerebral Hemorrhage (HCC 248) with a community, non-dual, aged base RAF weight of 0.289. P52.5 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Subarachnoid hemorrhage is located in a specific anatomical space; confirm this location is documented before assigning this code. Because P52.5 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P52.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Subarachnoid hemorrhage is located in a specific anatomical space; confirm this location is documented before assigning this code
- •Distinguish from subdural hemorrhage (bleeding between other membrane layers) which would use a different code
Clinical Significance
Subarachnoid hemorrhage of newborn involves bleeding in the space between the brain surface and the arachnoid membrane, often associated with birth trauma or asphyxia. While sometimes less severe than other intracranial hemorrhages, it can still cause increased intracranial pressure, seizures, and potential neurodevelopmental complications requiring careful monitoring.
Documentation Requirements
- ✓Imaging showing blood in subarachnoid space
- ✓Confirmation of nontraumatic etiology
- ✓Gestational age and birth weight
- ✓Associated perinatal complications
- ✓Neurological examination findings
- ✓Seizure monitoring results
- ✓CSF analysis if lumbar puncture performed
- ✓Follow-up imaging and assessments